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Doctors Lounge - Urology Answers
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| ridley
- Wed Sep 09, 2009 3:15 pm |
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I understand that impotence is one of the major side effects of prostatectomy, but I am curious to know, first, if the incidence of impotence is significantly lower when the robotic method of surgery is used, and secondly, if there have been any recent improvements in the treatment of surgical onset impotence. In the past, none of the pills, nor Muse, nor vacuum devices, nor any combination of these three, have been of any help.
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| Dr.M.Aroon kamath
- Sun Oct 18, 2009 10:32 pm |
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 Hi,
Thank you for your post. Firstly i would like to clarify that impotence is an important complication following 'Radical' prostatectomies - although to a lesser extent with 'open prostatectomies'.
Remember that more often than not,a surgeon would be behind a robotic surgery as well!
So, what is important is the personal experience of the operating surgeon,the 'volume' of cases of this sort done at a given institution and the unique situations for a given case (anatomical variations etc).
ICI(Intracavernous injection) therapy with various agents such as prostaglandin E1 (PGE1) and a combination of phentolamine, papaverine, and PGE1 (Trimix). Quadrimix (Trimix + atropine) etc have been tried with varying success rates.
Vacuum erection devices (VEDs) also form an important part of the urologist’s armamentarium for patients with post prostatectomy erectile dysfunction. They offer an additional option for post-radical prostatectomy patients who fail to have response to ICI (or can be used in combination with ICI therapy).
'Patient and partner acceptance' in decisions about long-term usage of erectogenic agents is mandatory for successful outcomes.Good luck!
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